National Environmental
Health Association Resolution Position on

The NEHA Board of Directors (BOD), having reviewed
the “Strengthening Partnerships between Environmental Public Health
Professionals and Public Health Nurses” draft advanced by CDC, submits the
following commentary and position on this matter. This does not represent a
formal policy position on behalf of the board. It rather is a commentary on
points raised in the paper cited above. It further represents a consensus of
the board on the larger view within the environmental health community
concerning the proposed enhanced cooperation between environmental health professionals
and public health nurses.

BOARD
COMMENTARY:

NEHA members
are acutely aware of the new challenges facing environmental/public health
programs as we enter a new century. The expectations for these programs from
policy-makers and the general public they serve have never been higher. The
needs being imposed on these programs in a post September 11th world
are fundamentally changing the very definition of what it means to be an
environmental/public health professional. This paradigm shift is occurring at a
time when other realities are producing tighter budgets, increased workloads
and fewer qualified personnel that are entering or remaining in the profession.
In short, there are fewer resources, less capacity and greater demands on the
public/environmental health infrastructure in our country.

Given these challenges, and mindful of the
responsibility within the profession to be

both proactive and positive in proposing solutions,
the NEHA-BOD is supportive of the concept of enhanced cooperation between EH
professionals and public health nurses. We, in fact, would note several areas
where successful collaborations are already occurring. For example, in
foodborne disease outbreak investigations, IAQ investigations such as asthma
trigger investigations in schools, problems arising in occupational health and
safety, and finally in community health promotion activities, there are
currently successful collaborations occurring between PH nurses and EH
professionals. A commitment between both sets of professionals is necessary. It
would serve to identify other areas where combining the experience and
expertise of the two groups would have beneficial results. It no doubt could
produce enhanced cooperation and improved efficiency in public health services
delivery.

Given both the high priority NEHA places on the
subject and its current urgency, we would like to make special mention of the
topic area of Terrorism Response and Emergency Preparedness. The NEHA BOD
believes that in any number of ways, we should explore linkages that would
provide a more coordinated and integrated local environmental public health
response in the event of a terrorism or emergency incident. Most notably, this
would be related to the need for effective disease surveillance and epidemiological
investigation and response. A more coordinated team approach to response and
remediation efforts between EH and PHN professionals would greatly enhance the
local public health capacity to react to these situations.

Moreover, we would note and support what we believe
to be a general consensus around one of the underlying assumptions of the CDC
draft paper. That being the view that, for the good of the public health
system, we need to “rethink” structure, relationship, service delivery and
quality, and to explore where the two professions could support and complement
one another. NEHA is uniquely well-qualified and positioned to represent
environmental health professionals in discussions with public health nurses
around these issues, and we would welcome the opportunity to do so.

At the outset of this process, however, the NEHA
board would also note some areas of concern that would also have to be
addressed as a fundamental part of the strengthening partnerships discussion.
The specific policy areas where we need further clarification and resolution
are as follows:

Compartmentalization/Turf:The board would note, with some concern, that
all too often in local health departments traditional clinically-based public
health programs are given priority over environmental health programs. This
produces a dynamic that impairs what should otherwise be a more cooperative
approach between the two groups. The extent to which the position paper fails
to address this concern needs to be explored in developing a mutually
acceptable policy. More specifically, our view is that the position paper
pre-supposes a need for a more active role in EH by PH nurses, while there was
no commensurate role for EH in any clinically-based programs within local
health departments. It was an additional concern that perhaps the position
paper envisioned a separate “niche” for PH nurses in EH. While we believe that
in developing and fostering a climate of improved cooperation between the two
groups additional areas of commonality would become apparent, we would also
stress the need to retain the individual character of each program’s
contribution to the public health system.

Differences in education, training and focus:The
board feels compelled to note differences between the two groups in this area.
While integrating (to some degree) the two workforces is a worthy goal,
nevertheless, attempting this integration that by definition involves two
workforces with different education, training, focus and responsibilities in
the public health system will present challenges. PH Nurses often play a key
role in both management and delivery of services in a clinical setting. It is
very much an orientation toward personal health care. Even the preventative
aspects of traditional PH nursing programs are personal health care based. By
its very nature, environmental health is the reverse of the PH nurses’
orientation and focus. EH is more macro in its philosophy and approach. These
differences are apparent and well noted. Given that, the board believes that
any successful attempt at enhancing the partnership between the two groups must
include resolving their respective roles and responsibilities within this
framework presented by a new partnership model. A frank discussion of these
differences and their effect on a model of enhanced cooperation between the two
groups is a predicate to effective cooperation.

At the core of
our concern is a generally held belief that clearly there would be no “spill
over” from EH to the more traditional public health programs. There was,
however, a potential for spill over from PH programs into EH. The concern was
that PH nurses, while maintaining their control over these programs, would then
move into an area that would involve them in traditional areas of EH. This is
far more than just a turf issue. It goes to a basic concern about the quality
of environmental health services. PH nurses simply do not have the education or
training to adequately address EH problems or to actively manage EH programs.
NEHA board members felt that EH embodied a specialized set of knowledge and
skills that needed to be respected and protected. It is unclear the degree to
which what was presented as an improved partnership would become a diminution
of EH or would evolve into a system that would marginalize the EH professionals
that are best prepared to address environmental health concerns. It should
also be noted that every example of collaboration noted earlier involved a team
approach model that still maintained the separation of the individual disciplines.
Simply put, the board is willing to explore enhanced cooperation based upon a
team approach, but one that respects the differences in education, training and
focus between the two groups.

Differences in status, funding, salary and visibility: The board also wished to note the disparity between
PH Nurses and EH professionals with regard to salary, visibility, political
support and management responsibilities. There is a thirty-year history over
which a trend has evolved in which PH nurses in local health departments have
gained an upper hand in these areas. The board’s concern is that a side effect
of this partnership model (admittedly an unintended one) would be to reinforce
this disparity. Put bluntly, having PH nurses involved with EH programs and
doing EH work could undermine the visibility and support that EH programs are
attempting to build within local communities and within the management of local
health departments.

Defining the dimensions of
the problem: In developing a consensus position for this policy statement
there was the widely held view that we need to better quantify the dimensions
of the problem. More directly, there are assumptions and premises upon which
the paper is founded, without quantifying the scope of the problem. Is there a
need (for any of the reasons stated in the paper) for PH nurses to become
involved in EH? Additionally, given some of the workforce supply challenges
that everyone acknowledges are there, does the solution rest with increased
collaboration between EH professionals and PH nurses? The NEHA board believes
that these questions need to be explored more fully before committing to a
proposed remedy.